The claim to service connection for sarcoidosis is reopened and granted.
Dr. Craig Bash has done thousands of case evaluations at the VA Hospital/regional office/BVA and court levels.
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Citation Nr: 19110591 Decision Date: 02/08/19 Archive Date: 02/08/19 DOCKET NO. 14-21 046 DATE: February 8, 2019 ORDER An effective date earlier than May 24, 2012, for the grant of service connection for posttraumatic stress disorder is denied. The claim to service connection for sarcoidosis is reopened and granted. The claim to service connection for a cervical spine disorder is reopened and denied. Service connection for a lumbar spine disorder is denied. Service connection for anemia is denied. Service connection for an eye disorder is denied. Service connection for a nutritional deficiency is denied. Service connection for arthritis is denied. Service connection for a skin disorder is denied. Service connection for a chronic respiratory disorder is denied. Service connection for chest pain is denied. Service connection for allergic rhinitis is denied. Service connection for gastritis is denied. Service connection for a fatigue disorder is denied. Service connection for a headache disorder is denied. Service connection for gastroesophageal reflux disease is denied. Service connection for a throat disorder is denied. Service connection for Parkinson’s disease is denied. Service connection for a heart disorder is denied. Service connection for a liver disorder is denied. Service connection for a kidney disorder is denied. Service connection for a stomach disorder is denied. Service connection for adult acne is denied. Service connection for a chronic left ankle disorder is denied. Service connection for a chronic right ankle disorder is denied. Service connection for a chronic left knee disorder is denied. Service connection for a chronic bilateral hip disorder is denied. Service connection for a chronic left elbow disorder is denied. Service connection for a chronic right elbow disorder is denied. Service connection for a chronic left shoulder disorder is denied. Service connection for a chronic right shoulder disorder is denied. Service connection for pseudofolliculitis barbae is denied. Service connection for hemorrhoids is denied. Service connection for residuals of a traumatic brain injury is denied. The appeal for entitlement to a total disability rating based on individual unemployability as a result of service connected disabilities is dismissed. REMANDED The claim for service connection for an ear disorder, to include bilateral hearing loss and ear drum damage, is remanded. The claim for service connection for a sleep disorder, to include obstructive sleep apnea, is remanded. The claim for service connection for irritable bowel syndrome is remanded. FINDINGS OF FACT 1. The Veteran’s request to reopen the previously denied service connection claim for posttraumatic stress disorder (PTSD) was received on May 24, 2012. 2. In an October 2009 rating decision, the Veteran’s service connection claims for sarcoidosis and a cervical spine disorder were denied. 3. The evidence received since the October 2009 rating decision includes evidence that relates to an unestablished fact necessary to substantiate the claims for service connection for sarcoidosis and a cervical spine disorder and, is neither cumulative nor redundant of evidence already of record, and raises a reasonable possibility of substantiating the claims. 4. Resolving all doubt in favor of the Veteran, his sarcoidosis is the result of his active service. 5. The weight of the evidence is against a finding that any cervical spine disorder, lumbar spine disorder, anemia, eye disorder, a nutritional deficiency, arthritis, a skin disorder, to include adult acne, rash, and soft tissue tumor, a chronic respiratory disorder, to include asthma, bronchitis, and chronic obstructive pulmonary disease, chest pain, allergic rhinitis, gastritis, a fatigue disorder, a headache disorder, gastroesophageal reflux disease (GERD), a throat disorder, Parkinson’s disease, heart disorder (to include ischemic heart disease and hypertension), a liver disorder, a kidney disorder, a stomach disorder, chronic bilateral ankle disorder, chronic left knee disorder, chronic bilateral hip disorder, chronic bilateral elbow disorder, chronic bilateral shoulder disorder, pseudofolliculitis barbae (PFB), hemorrhoids, or residuals from a traumatic brain injury (TBI) began during or was otherwise caused by the Veteran’s active service. 6. As a 100 percent schedular rating has been assigned to the service-connected PTSD, the matter of entitlement to a total disability rating based on individual unemployability as a result of service connected disabilities (TDIU) rating is rendered moot. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than May 24, 2012, for the grant of service connection for PTSD have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.156, 3.400. 2. The October 2009 rating decision that denied service connection for a cervical spine disorder and sarcoidosis is final. 38 U.S.C. § 7105(c) (2006); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2009). 3. New and material evidence has been received since the October 2009 rating decision that is sufficient to reopen the Veteran’s claims of entitlement to service connection for a cervical spine disorder and sarcoidosis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. The criteria for service connection for sarcoidosis have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 5. The criteria for service connection for a cervical spine disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 6. The criteria for service connection for a lumbar spine disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 7. The criteria for service connection for anemia not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 8. The criteria for service connection for an eye disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 9. The criteria for service connection for a nutritional deficiency not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 10. The criteria for service connection for arthritis not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 11. The criteria for service connection for a skin disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 12. The criteria for service connection for a chronic respiratory disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 13. The criteria for service connection for chest pain not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 14. The criteria for service connection for allergic rhinitis have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 15. The criteria for service connection for gastritis have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 16. The criteria for service connection for a fatigue disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 17. The criteria for service connection for a headache disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 18. The criteria for service connection for GERD have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 19. The criteria for service connection for Parkinson’s disease have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 20. The criteria for service connection for a heart disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303 21. The criteria for service connection for a chronic liver disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 22. The criteria for service connection for a chronic kidney disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 23. The criteria for service connection for a chronic stomach disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 24. The criteria for service connection for a chronic throat disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 25. The criteria for service connection for adult acne not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 26. The criteria for service connection for a chronic left ankle disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 27. The criteria for service connection for a chronic right ankle disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 28. The criteria for service connection for a chronic left knee disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 29. The criteria for service connection for a chronic left hip disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 30. The criteria for service connection for a chronic right hip disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 31. The criteria for service connection for a chronic left elbow disorder have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 32. The criteria for service connection for a chronic right elbow disorder not have been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 33. The criteria for service connection for a chronic left shoulder disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 34. The criteria for service connection for a chronic right shoulder disorder have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 35. The criteria for service connection for PFB have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 36. The criteria for service connection for hemorrhoids have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. 37. The criteria for service connection for a TBI have not been met. 38 U.S.C.§ 1131; 38 C.F.R. § 3.303. 38. The claim for a TDIU is dismissed. 38 C.F.R. § 4.16(a) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Air Force from January 1977 to June 1979. In connection with this appeal, the Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2016. A transcript of that hearing is of record. In January 2016, the RO granted service connection for PTSD and granted basic eligibility to Dependents’ Education Assistance. This represents a complete grant of his appeal in regard to these claims. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). These issues are no longer before the Board. Earlier Effective Date A January 2016 rating decision granted service connection for PTSD with an effective date of May 24, 2012, the day the request to reopen the previously denied claim for service connection for PTSD was received by VA. The Veteran asserts that he is entitled to an earlier effective date. At the outset, it is important to consult the general rule for earlier effective dates for service connection, to determine if it allows the benefit sought. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement will be either the day following separation or the date entitlement arose. 38 U.S.C. § 5110(b)(1). If a claim is not received within a year of separation, VA regulations provide that the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101 (a). A “claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Any communication indicating an intent to apply for a benefit under the laws administered by VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155 (a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). A review of the record shows that the Veteran’s initial claim was denied by an October 2009 rating decision. The first communication from the Veteran indicating an intent to reapply for benefits for PTSD (i.e. to reopen a previously denied claim) was received on May 24, 2012. An intent to apply for benefits is an essential element of any claim, whether formal or informal, and, further, the intent must be communicated in writing. See Criswell v. Nicholson, 20 Vet. App. 501, 504 (2006). Despite the fact that the Veteran’s PTSD is clearly due to his active service, the date entitlement arose, he did not file a request to reopen his service connection claim for PTSD until May 24, 2012. As such, the date of receipt of claim is the later of the date of entitlement and the date of claim, and VA regulations dictate that the date of receipt of claim should be the effective date that is assigned. Accordingly, the claim for an effective date earlier than May 24, 2012, for the grant of service connection for PTSD is denied. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established under 38 C.F.R. § 3.303(b), where a condition in service is noted but is not, in fact, chronic, or where a diagnosis of chronicity may be legitimately questioned. The continuity of symptomatology provision of 38 C.F.R. § 3.303(b) has been interpreted as an alternative to service connection only for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service connected disability; and (3) medical nexus evidence establishing a connection between the service connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). Sarcoidosis The Veteran’s service connection claim for sarcoidosis was previously denied by an October 2009 rating decision. The Veteran has sought to reopen his previously denied claim. The claim is reopened based on medical evidence that links the Veteran’s sarcoidosis to his active service. Accordingly, the claim is reopened. The Veteran filed a service connection claim for sarcoidosis. The Veteran asserts that his sarcoidosis is due to his active service. Based on the Veteran’s claim, the Board sent his appeal for an expert medical opinion. In May 2018, a VA pulmonologist reviewed the Veteran’s claims file and opined that the Veteran’s sarcoidosis at least as likely as not began during or was caused by exposures related to his active service. The opinion of the VA pulmonologist is given great probative weight as he reviewed objective medical evidence, referred to objective medical studies, and opined that the Veteran’s sarcoidosis was at least as likely as not due to his active service. Having weighed the evidence of record, the Board finds that the evidence for and against the Veteran’s claim is in relative equipoise. Accordingly, the Veteran’s claim for service connection for sarcoidosis is granted. Other Conditions The Veteran’s service connection claim for a cervical spine disorder was previously denied by an October 2009 rating decision. The Veteran has sought to reopen the claim. The claim is reopened based on additional medical and lay evidence that suggest the possibility of a link the Veteran’s cervical spine disorder to his active service. Of note, this evidence is presumed to be credible for the limited purpose of reopening the claim. The Veteran filed his service connection claims for a cervical spine disorder, lumbar spine disorder, anemia, eye disorder, a nutritional deficiency, arthritis, a skin disorder, a chronic respiratory disorder, chest pain, allergic rhinitis, gastritis, a fatigue disorder, a headache disorder, GERD, a throat disorder, Parkinson’s disease, ischemic heart disease, a liver disorder, a kidney disorder, a stomach disorder, adult acne, chronic bilateral ankle disorder, chronic left knee disorder, chronic bilateral hip disorder, chronic bilateral elbow disorder, chronic bilateral shoulder disorder, PFB, hemorrhoids, and a TBI, which were denied by August 2012 and October 2013 rating decisions. He asserts that he has the above conditions as a result of his active service. He asserts that these conditions are due to radiation exposure, asbestos exposure, and/or secondary to his service connected disabilities, which are sarcoidosis, tinnitus, and PTSD. The Veteran’s STRs show that at his entrance physical, he denied having any of the above conditions and had a normal examination. In December 1977, he was diagnosed with an upper respiratory infection. In June 1979, he was diagnosed with allergic rhinitis. At his separation physical, he had a normal physical examination but for abdominal tenderness with voluntary guarding. He denied having any above conditions. Furthermore, his STRs contain no evidence of any radiation or asbestos exposure. The Veteran has submitted multiple lay statements from himself and people he knows regarding his assertions. He has also submitted multiple medical articles. The Veteran’s medical records show that a February 1986 x-ray of his bilateral knees was normal. An August 1986 chest x-ray showed a normal heart and normal lungs. In June 1994, he treated for pseudofolliculitis barbae (PFB). In November 1995, he treated for recurrent pimples. In June 1996, he reported having no problems sleeping. His nose and lungs were clear, he had no nodules, his heart and lungs were normal, he had a normal gait, and he retained normal 5/5 muscle strength. In July 1996, he treated for nasal congestion and upper respiratory infection. He had full range of motion of his shoulders, elbows, and wrists with no arthritis diagnosis. In January 1997, the Veteran reported having headaches all the time. In February 1997, he reported having left foot pain that began the day before and chest pain. In March 1997, he reported neck pain. In March 1997, April 1997 and May 1997, he was diagnosed with headaches, skin rash, and joint pains. In April 1997, he was diagnosed with a mild cervical sprain. In September 1997, he had a normal physical examination. X-rays were all normal. In October 1997, he reported spraining his left ankle two weeks previously. In November 1997, he was diagnosed with joint pain. In April 1998, the Veteran reported having headaches, left leg pain, and neck pain. In July 2001, he complained of headaches and back pain after being assaulted by the police. In August 2001, he denied any history of eye symptoms, neck symptoms, gastrointestinal symptoms, or genitourinary system symptoms. He also had denied any lymphatic symptoms or neurological symptoms, as well as any joint or bone pain, swelling, or tenderness. In September 2001, a chest x-ray showed no signs of an active cardiac or pulmonary abnormality. A brain MRI and head CT were both normal. In February 2003, he reported smashing his right hand. He had x-rays of his cervical spine, lumbar spine, shoulders, wrists, and hands, which were all normal. In March 2003, the Veteran was afforded a VA examination. He had a normal examination of his hands, wrists, shoulders, hips, knees, and ankles. X-rays of his cervical spine, lumbar spine, shoulders, wrists, and hands were normal. In February 2006, the Veteran reported low back pain after slipping on ice a couple of weeks previously. In August 2009, x-rays of his cervical spine and lumbar spine were normal. In January 2010, x-rays of his elbows were normal. In June 2011, x-rays of his lumbar spine and knees were normal. In September 2011, he treated for neck pain, back pain, headaches, vision complaints, knee problems, shoulder problems, chest pain, and hearing problems that resulted from a motor vehicle accident that occurred three weeks previously. He met the criteria for a mild TBI. A cervical spine x-ray was normal. In May 2012, he reported a change in his vision. In February 2013, x-rays of his knees showed degenerative changes. In October 2014, a cervical spine x-ray was within normal limits. In February 2015, a cervical spine x-ray showed mild arthritis. In March 2015, Dr. Jerry Bush reviewed the Veteran’s claims file. Dr. Bush opined that the Veteran’s cervical spine disorder was as likely as not due to his active service. Dr. Bush reported that the Veteran had repetitive significant physical demands during his active service. In June 2015, Dr. Craig N. Bash reviewed the Veteran’s claims file. Dr. Bash opined that the Veteran experienced a TBI during his active service. In October 2015, a VA examiner reviewed the Veteran’s claims file. The examiner opined that the Veteran’s headache disorder was less likely than not due to his active service or caused or aggravated by his service connected tinnitus. In October 2015, Dr. Bash opined that the Veteran’s cervical spine disorder was due to a motor vehicle accident during his active service. In December 2015, a VA examiner reviewed the Veteran’s claims file. The examiner reported that the Veteran did not have a diagnosis of a TBI. In May 2018, a VA pulmonologist reviewed the Veteran’s claims file, which included the medical opinions from Drs. Bush and Bash. The VA pulmonologist opined that the Veteran’s anemia, eye disorder, nutritional deficiency, arthritis, skin disorder, lumbar spine disorder, respiratory disorder, chest pain, allergic rhinitis, sinusitis, gastritis, fatigue disorder, headache disorder, GERD, a throat disorder, Parkinson’s disease, a heart disorder, a liver disorder, a kidney disorder, and a stomach disorder were less likely than not due to his service connected sarcoidosis. The pulmonologist explained that the evidence of record suggested that the Veteran has pulmonary stage I sarcoidosis with bilateral hilar prominence, noting that no parenchymal infiltrates were noted. The pulmonologist noted that the Veteran was not currently getting treated for sarcoidosis and had preserved lung function. As such, while sarcoidosis can affect any organ system, there was not sufficient evidence in the Veterans case to indicate extra-pulmonary organ involvement. When evaluating the evidence of record, the Board must assess the credibility and probative value of the evidence, and, provided that it offers an adequate statement of reasons or bases, the Board may favor one medical opinion over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). While the Board is not free to ignore the opinion of a treating physician, it is free to discount the credibility of that physician’s statement. See Guerrieri v. Brown, 4 Vet. App. 467, 471-73 (1993). Here several medical opinions are of record, all of which were provided by medical professionals who are presumed to have the training and expertise to opine on an orthopedic condition. As such, each opinion is considered to constitute both competent and credible evidence, which is deemed to be probative. However, the Board must determine what evidence is the most probative. Regarding the Veteran’s cervical spine disorder, Drs. Bush and Bash opined that the Veteran’s cervical spine disorder was more likely than not due to his active service. Dr. Bush felt that the Veteran’s cervical spine disorder was due to physical demands from the Veteran’s active service. Dr. Bash reported that the Veteran was in a motor vehicle accident during his active service. However, the Veteran’s STRs do not show treatment for a cervical spine disorder or that he experienced a motor vehicle accident during service. The medical record shows that he had normal cervical spine x-rays in February 2003, March 2003, August 2009, September 2011, and October 2014. It is not until February 2015 that a cervical spine x-ray showed mild arthritis, over 35 years after his separation from service. As such, the opinions of Drs. Bush and Bash are given little weight as neither is consistent with the evidence of record showing that the Veteran was not diagnosed with a chronic cervical spine disorder until February 2015. Moreover, neither doctor explained why the normal cervical spine x-rays taken decades after service should be ignored. As such, the Veteran’s medical records are given the greatest probative weight. Regarding the Veteran’s headache disorder, an October 2015 VA examiner opined that the Veteran’s headache disorder was less likely than not due to his active service or caused or aggravated by his service connected tinnitus. As noted, the examiner noted that the Veteran’s headaches did not begin in service or within several years of service. Conversely, Dr. Bash’s opinion is based on the conclusion that the Veteran’s headaches began in service. However, on a medical history survey completed in conjunction with his separation physical the Veteran specifically denied experiencing headaches at that time. That is the Veteran had the opportunity to indicate headaches if he was in fact experiencing them, but he denied their presence. As such, the Board believes that the VA examiner’s opinion is more congruent with the Veteran’s medical records, and therefore the October 2015 VA examiner’s opinion is given the greatest probative weight. Regarding the Veteran’s arthritis, skin disorder, respiratory disorder, left knee disorder, and PFB, the Veteran has not submitted any medical evidence supporting his contention that any of those conditions were either due to or otherwise the result of his active service. Essentially, at his hearing he related many of these conditions to his sarcoidosis. However, as was most credibly explained by the VA pulmonologist, the Veteran’s sarcoidosis had not been shown to expand beyond his lungs, and therefore, contrary to what was asserted in other medical opinions of record the Board finds the most persuasive evidence to be that the sarcoidosis, which has thus far been found to be restricted to the lungs, has not impacted other areas in the Veteran’s body. Therefore, after weighing all the evidence, the Board finds the greatest probative value in the VA examiner’s opinions and the medical evidence orf record, which weighs against the conclusion that the Veteran’s arthritis, skin disorder, respiratory disorder, left knee disorder, or PFB either began during or were otherwise caused by his active service. Thus, the evidence fails to establish service connection for the Veteran’s arthritis, skin disorder, respiratory disorder, left knee disorder, or PFB. Consideration has been given to the Veteran’s assertions that these conditions are the result of his active service. He is clearly competent to report symptoms. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, while the Veteran may describe symptoms of these conditions, he lacks the medical training or qualification to either diagnose a chronic disability or opine as to its etiology. Id. His opinion therefore cannot provide the requisite nexus and does not refute the medical opinions and medical evidence of record. Accordingly, the criteria for service connection have not been met for a chronic cervical spine disorder, a headache disorder, arthritis, a skin disorder, a respiratory disorder, a left knee disorder, and PFB. That is, the evidence does not show that these conditions were diagnosed in service or within a year of service, and the weight of the evidence is against a finding that a chronic cervical spine disorder, a headache disorder, arthritis, a skin disorder, a respiratory disorder, a left knee disorder, or PFB has existed continuously since service. Therefore, the claims are denied. Regarding the Veteran’s service connection claims for a lumbar spine disorder, anemia, eye disorder, nutritional deficiency, chest pain, allergic rhinitis, gastritis, a fatigue disorder, GERD, a throat disorder, Parkinson’s disease, ischemic heart disease, a liver disorder, a kidney disorder, a stomach disorder, bilateral ankle disorder, bilateral elbow disorder, bilateral shoulder disorder, and hemorrhoids, the Veteran’s medical records do not show evidence of a current chronic disability for these conditions. In August 1986, he had normal heart findings on a chest x-ray. In June 1996, he had a normal examination of his heart. In October 1997, he reported spraining his ankle, but x-rays were normal. In August 2001, the Veteran reported he did not have a history of eye symptoms. He had normal lumbar spine x-rays in September 2001, March 2003, August 2009, and June 2011. He had normal x-rays of his shoulders in February 2003 and March 2003. He had normal ankle and hip x-rays in March 2003. He had normal x-rays of his elbows in January 2010. Regarding the Veteran’s service connection claim for a TBI, his medical records show he was in a motor vehicle accident in September 2009, and at the time, he met the criteria for a mild TBI. However, his medical records do not show a diagnosis of a TBI. While Dr. Bash opined that the Veteran’s TBI was due to his active service, the Veteran’s STRs do not show any complaints, symptoms, treatment, or diagnosis for a TBI during his active service. A December 2015 VA examiner reported that the Veteran did not have a diagnosis of a TBI. The Veteran testified to being involved in a motor vehicle accident while in service, but the claims file, including service treatment records, do not describe any such incident, and the Board believes that had the Veteran been involved in a motor vehicle accident of the impact he described there would be some mention of it in the Veteran’s extensive service treatment records, including a medical history survey that the Veteran completed himself. As such, the Veteran’s medical records do not show a diagnosis of a lumbar spine disorder, anemia, eye disorder, nutritional deficiency, chest pain, allergic rhinitis, gastritis, a fatigue disorder, GERD, a throat disorder, Parkinson’s disease, ischemic heart disease, a liver disorder, a kidney disorder, a stomach disorder, bilateral ankle disorder, bilateral elbow disorder, bilateral shoulder disorder, hemorrhoids, or a TBI. While the Veteran contended that he has a lumbar spine disorder, anemia, eye disorder, nutritional deficiency, chest pain, allergic rhinitis, gastritis, a fatigue disorder, GERD, a throat disorder, Parkinson’s disease, ischemic heart disease, a liver disorder, a kidney disorder, a stomach disorder, bilateral ankle disorder, bilateral elbow disorder, bilateral shoulder disorder, hemorrhoids, and a TBI, the diagnosis of these conditions requires clinical testing and medical expertise, and cannot simply be diagnosed by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to diagnose such a disability and related it to his service or to a service connected disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, there is then no need to address whether his lay statements in this regard are also credible. Id. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Admittedly, the requirement that a current disability be present is satisfied “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim...even though the disability resolves prior to the Secretary’s adjudication of the claim.” McClain v. Nicholson, 21 Vet. App. 319 (2007). Here, however, the Veteran has not shown by medical evidence the presence of a lumbar spine disorder, anemia, eye disorder, nutritional deficiency, chest pain, allergic rhinitis, gastritis, a fatigue disorder, GERD, a throat disorder, Parkinson’s disease, ischemic heart disease, a liver disorder, a kidney disorder, a stomach disorder, bilateral ankle disorder, bilateral elbow disorder, bilateral shoulder disorder, or hemorrhoids. The evidence is also unclear whether the Veteran has residuals of a TBI. However, even if the Veteran were found to have residuals of a TBI, the evidence of record does not show it was the result of any incident in service, but rather was the result of a motor vehicle accident that occurred years after service. Accordingly, the criteria for service connection for a lumbar spine disorder, anemia, eye disorder, nutritional deficiency, chest pain, allergic rhinitis, gastritis, a fatigue disorder, GERD, a throat disorder, Parkinson’s disease, ischemic heart disease, a liver disorder, a kidney disorder, a stomach disorder, bilateral ankle disorder, bilateral elbow disorder, bilateral shoulder disorder, hemorrhoids, or a TBI have not been met, and the Veteran’s claims are denied. TDIU The Board notes that a 100 percent schedular rating has been assigned to the service-connected PTSD, and therefore, the matter of entitlement to a TDIU rating is rendered moot. The regulations pertaining to the assignment of a TDIU rating provide that such a rating may be assigned where the schedular rating is less than total. 38 C.F.R. § 4.16(a). In light of the fact that the Veteran has been assigned a 100 percent schedular evaluation for the service-connected PTSD and has not specifically alleged that another service connected disability or combination of disabilities has rendered him unable to obtain or maintain substantially gainful employment, the issue of TDIU is moot. REASONS FOR REMAND Regarding the Veteran’s service connection claim for an ear disorder, to include hearing loss and an eardrum disorder, he asserts his ear disorder is due to his active service. The Veteran’s STRs show that between a December 1976 audiological examination and a January 1979 audiological examination, he had 5 decibel threshold shifts at the 500, 1000, and 4000 hertz levels and a 10 decibel shift at the 2000 hertz level. The Veteran was afforded VA examinations in December 2009, May 2012, and January 2013. However, the examiners all reported that the audiological examinations were not reliable. However, in January 2014, the Veteran’s treating provider reported that he had mild hearing loss. As such, the Board finds that the Veteran should be afforded a new VA examination to obtain an opinion on the significance, if any, of the minimal threshold shifts in hearing acuity during the Veteran’s active service. Regarding the Veteran’s service connection claim for a sleep disorder and irritable bowel syndrome, the Veteran asserts that these conditions are secondary to his service connected PTSD. As such, a remand is necessary to obtain on opinion on the etiology of the Veteran’s sleep disorder and irritable bowel syndrome. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA audiology examination. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s bilateral hearing loss either began during or was otherwise caused by his military service, to include noise exposure sustained therein. Why or why not? The examiner should specifically comment on the clinical significance, if any, of threshold shifts in the Veteran’s hearing acuity during his active service and whether those shifts suggest that jet noise exposure caused his current hearing loss. 2. Schedule the Veteran for a VA examination to determine the etiology of his sleep disorder and irritable bowel syndrome. The examiner should offer the following opinions: a. Is it at least as likely as not (50 percent or greater probability) that any sleep disorder and/or irritable bowel syndrome either began during or was otherwise caused by the Veteran’s active service? Why or why not? b. Is it at least as likely as not (50 percent or greater) that any sleep disorder and/or irritable bowel syndrome was caused by a service connected disability, such as his PTSD? Why or why not? c. Is it at least as likely as not (50 percent or greater) that any sleep disorder and/or irritable bowel syndrome was aggravated (made worse) by a service connected disability? Why or why not? (Continued on the next page) If aggravation is found, the examiner should identify the baseline level of severity of the sleep disorder and/or irritable bowel syndrome before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the disability. 38 C.F.R. § 3.310. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Berryman, Counsel